Provider Demographics
NPI:1972719185
Name:CROWN CITY ADHC, INC.
Entity Type:Organization
Organization Name:CROWN CITY ADHC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:STEINE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:626-583-8822
Mailing Address - Street 1:122 N EL MOLINO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1805
Mailing Address - Country:US
Mailing Address - Phone:626-583-8822
Mailing Address - Fax:626-583-8844
Practice Address - Street 1:122 N EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1805
Practice Address - Country:US
Practice Address - Phone:626-583-8822
Practice Address - Fax:626-583-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAADU70216FMedicaid